Healthcare Provider Details

I. General information

NPI: 1992095723
Provider Name (Legal Business Name): SARAH PRICE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 09/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MEMORIAL DR
BELLEVILLE IL
62226-5368
US

IV. Provider business mailing address

4600 MEMORIAL DR
BELLEVILLE IL
62226-5368
US

V. Phone/Fax

Practice location:
  • Phone: 314-283-7458
  • Fax:
Mailing address:
  • Phone: 314-283-7458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP8528
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number336102099
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: